Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0013395 (dyspepsia)
 4,879 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Fifty-four patients on haemodialysis for chronic renal failure underwent renal transplantation. Basal and maximum acid output and the incidence of peptic ulcer before transplantation were not significantly different from those of controls. But after renal transplantation the incidence of symptoms of peptic ulcer was high (22%) and four out of six patients who developed gastrointestinal bleeding died from this complication. In men peak acid output was significantly increased after renal transplantation and was associated with a 30% incidence of symptoms of peptic ulcer compared with 10% in women, who showed no significant change in mean basal or peak acid output. Peptic ulceration after transplantation was not associated with steroid dosage, hyperparathyroidism, or the height of blood urea concentrations. Given criteria of a history of dyspepsia, abnormal barium meal findings, or gastric hypersecretion, it was not possible to identify patients at risk from peptic ulceration or life-threatening complications after renal transplantation. Thus the routine screening of these patients for peptic ulcer has no practical value, and the incidence of fatal complications is not high enough to justify routine prophylactic anti-ulcer surgery aimed at reducing acid secretion before renal transplantation.
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PMID:Peptic ulceration, gastric secretion, and renal transplantation. 32 38

Two urease-based tests--the urease slide test and the radiolabeled urea breath test, are commonly used for the diagnosis of Helicobacter pylori infection of the stomach. The reliability of these tests in chronic uremia was compared with serological tests for H pylori antibodies, and with direct detection of the organism by microscopy or culture of gastric antral biopsies. Twenty-seven patients with chronic renal failure and dyspepsia underwent upper gastrointestinal endoscopy. Twelve of these patients (46%) were judged to be infected with H pylori on the basis of identification of the organism on microscopy or culture of antral biopsy. Both urease-based tests were able to determine H pylori status, despite the markedly increased concentrations of urea in the gastric juice found in chronic renal failure. The urease slide test performed on antral biopsies obtained at endoscopy proved reliable in determining H pylori status with no false-positive nor false-negative results after 20 minutes and 24 hours of incubation. The 14C-urea breath test also differentiated the infected from the uninfected patients. The 20-minute 14CO2 excretion (kg %dose/mmol CO2 x 100) ranged from 50 to 834 in the H pylori-infected patients, compared with 0.3 to 27 in the H pylori-noninfected patients (P < 0.0001); the 90-minute values ranged from 88 to 398 in the former, compared with 1 to 79 in the latter (P < 0.0001). The excretion of 14CO2 (derived from bacterial hydrolysis of ingested 14C-urea) was higher in all the uremic patients compared with nonuremic controls, and in half of the H pylori-noninfected uremic patients there was a late increase in 14CO2 excretion.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The diagnosis of Helicobacter pylori infection in uremic patients. 146 85

Individuals with chronic renal failure (CRF) may have a variety of gastrointestinal (GI) problems, including dyspepsia, acid peptic disease, and bacterial overgrowth. We investigated gastrointestinal function in 11 uremic patients, seven of whom were on dialysis three times a week and four who were not on dialysis. Ten normal subjects were studied as controls. The nutritional status of the patients did not differ from that of the control subjects. Seven patients demonstrated abnormal GI endoscopic findings, although none was severe; they also had prolonged oral-cecal transit times but had no evidence of bacterial overgrowth, and all had normal numbers of lymphocyte subpopulations within the intestinal mucosa. The patients had significantly reduced activities of mucosal sucrase and maltase but not of lactase. In spite of the reductions in these enzymatic activities, carbohydrate malabsorption was not evident in the CRF group, probably because of the vast reserve of the small intestine. No differences were noted between the groups in the activities of several intestinal peptidases. From these data, we concluded that GI function is essentially normal in patients with CRF and postulate that this normality, which is in contrast to previous findings, is related to recent advances in the clinical management of uremic patients.
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PMID:Gastrointestinal function, morphology, and immune status in uremia. 213 74

Forty-six consecutive patients with chronic renal failure (CRF) were assessed radiographically, endoscopically and histologically for duodenal inflammation. Their gastric secretion was also examined. Thirty-eight patients with non-ulcer dyspepsia served as controls. Histologically established duodenitis was more common in CRF patients than in controls. Among the non-dialyzed patients its prevalence reached 28% (9/32), while in the controls it was 5% (2/38) (p less than 0.05). The CRF patients with duodenitis had upper GI symptoms, hypersecretion of acid (p less than 0.05) and duodenal ulcer disease (p less than 0.05) more frequently compared with the CRF subjects with normal duodenal mucosa. The correlation of radiographically and endoscopically detected duodenitis with that found microscopically was poor.
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PMID:Increased incidence of duodenitis in chronic renal failure. 319 78

The milk-alkali syndrome is the association of hypercalcaemia and renal failure, with or without alkalosis, in the presence of absorption of excessive quantities of calcium, alkali, or both. Two patients with the milk-alkali syndrome are described, one representing an acute, reversible disorder and the other demonstrating a chronic syndrome with only partially reversible renal disease. Differential diagnosis is not difficult and is usually aided by the initial clinical evaluation as well as rapid response to conservative therapy. Because the initial stages of renal insufficiency are often fully reversible, the early identification and treatment of the milk-alkali syndrome can prevent progression to irreversible, chronic renal failure. Although non-absorbable antacids, H2 blockers, and sucralphate are the basis of modern treatment of peptic ulcer disease, the syndrome may still occur, especially in patients who self-treat symptoms of dyspepsia.
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PMID:The 'milk-alkali' syndrome: two case reports with discussion of pathogenesis. 400 10

Antacids are commonly used self-prescribed medications. They consist of calcium carbonate and magnesium and aluminum salts in various compounds or combinations. The effect of antacids on the stomach is due to partial neutralisation of gastric hydrochloric acid and inhibition of the proteolytic enzyme, pepsin. Each cation salt has its own pharmacological characteristics that are important for determination of which product can be used for certain indications. Antacids have been used for duodenal and gastric ulcers, stress gastritis, gastro-oesophageal reflux disease, pancreatic insufficiency, non-ulcer dyspepsia, bile acid mediated diarrhoea, biliary reflux, constipation, osteoporosis, urinary alkalinisation and chronic renal failure as a dietary phosphate binder. The development of histamine H2-receptor antagonists and proton pump inhibitors has significantly reduced usage for duodenal and gastric ulcers and gastro-oesophageal reflux disease. However, antacids can still be useful for stress gastritis and non-ulcer dyspepsia. The recent release of proprietary H2 antagonists has likely further reduced antacid use for non-ulcer dyspepsia. Other indications are still valid but represent minor uses. Antacid drug interactions are well noted, but can be avoided by rescheduling medication administration times. This can be inconvenient and discourage compliance with other medications. All antacids can produce drug interactions by changing gastric pH, thus altering drug dissolution of dosage forms, reduction of gastric acid hydrolysis of drugs, or alter drug elimination by changing urinary pH. Most antacids, except sodium bicarbonate, may decrease drug absorption by adsorption or chelation of other drugs. Most adverse effects from antacids are minor with periodic use of small amounts. However, when large doses are taken for long periods of time, significant adverse effects may occur especially patients with underlying diseases such as chronic renal failure. These adverse effects can be reduced by monitoring of electrolyte status and avoiding aluminum-containing antacids to bind dietary phosphate in chronic renal failure. Antacids, although effective for discussed indications of duodenal and gastric ulcer and gastro-oesophageal reflux disease, have been replaced by newer, more effective agents that are more palatable to patients. Antacids are likely to continue to be used for non-ulcer dyspepsia, minor episodes of heartburn (gastro-oesophageal reflux disease) and other clear indications. Although their wide-spread use may decline, these drugs will still be used, and clinicians should be aware of their potential drug interactions and adverse effects.
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PMID:Antacids revisited: a review of their clinical pharmacology and recommended therapeutic use. 1040 Apr 1

Gastrointestinal and hepatic disorders are commonly associated with end-stage renal disease, hemodialysis, and renal transplantation. Recent studies indicate that the prevalence of dyspepsia, ulcer disease, and Helicobacter pylori gastritis is not significantly different from the general population. Bleeding from angiodysplasia, however, is more common in chronic renal failure, as is gastroparesis. The prevalence of chronic hepatitis B has been dramatically reduced among hemodialysis patients since the advent of universal precautions. Response rates to hepatitis B vaccine in noninfected patients, however, are lower in these individuals. Chronic hepatitis C is found in 20% to 25% of HD patients worldwide and accounts for approximately 1% of all infected individuals. Levels of alanine aminotransferase and aspartase aminotransferase are often within normal limits but may be elevated compared with a patient's preinfection levels. Dialysis has been shown to reduce the level of hepatitis C virus viremia. Treatment is similar to non-renal failure patients, although interferon is generally not used in renal transplant recipients owing to concerns of graft failure.
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PMID:Gastrointestinal and hepatic disorders in end-stage renal disease and renal transplant recipients. 1092 10

Impaired gastric myoelectrical activity has been reported in patients with chronic renal failure (CRF). The effect of peritoneal dialysis on this function has not previously been described. The aim here was to investigate the effect of peritoneal dialysis on gastric myoelectrical activity. Gastric myoelectrical activity was recorded by electrogastrography (EGG) in 23 patients with CRF (18 with dyspepsia) during peritoneal dialysis and with the peritoneal cavity empty of dialysis fluid (14 patients), and in 20 healthy controls. Two 30-min EGG recordings before and after a solid test meal were analyzed using spectral analysis methods. No significant difference in the percentage of normal 2- to 4-cpm slow waves was found in patients on peritoneal dialysis compared to those with the peritoneal cavity empty of dialysis fluid or to controls (in fasting state 83 +/- 3%, 80 +/- 5% and 89 +/- 4%, in fed state 91 +/- 3%, 86 +/- 4% and 83 +/- 4%, respectively). It was found that the power ratio (change in power of normal slow waves in fed state) was significantly higher in the 14 patients on peritoneal dialysis compared to the same patients with the peritoneal cavity empty of dialysis fluid (27.2 +/- 10.7 vs 8.6 +/- 4.8, P < 0.05). There was no significant difference in the power ratio between patients with the peritoneal cavity empty of dialysis fluid and controls (8.6 +/- 4.8 vs 7.5 +/- 2.2). The subgroup of patients with no dyspepsia had a significantly higher power ratio compared to those with dyspepsia both on dialysis and with the peritoneal cavity empty of dialysis fluid (39.4 +/- 13.7 vs 12.4 +/- 5.2 and 29.2 +/- 21.5 vs 2.8 +/- 0.4 respectively, P < 0.05). In conclusion, there was no significant difference in gastric myoelectrical activity between patients with the peritoneal cavity empty of dialysis fluid and controls. Dialysis fluid in the peritoneal cavity seems to enforce the gastric myoelectrical signal.
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PMID:Effect of peritoneal dialysis on gastric myoelectrical activity in patients with chronic renal failure. 1176 55

The aim of this study was to evaluate the efficacy and safety of oral sildenafil to treat erectile dysfunction (ED) in chronic renal failure in patients on hemodialysis (HD). A double-blind, randomized, placebo-controlled study of oral sildenafil (50 mg) administered as required in HD patients with ED was designed. Patients on HD for at least 6 mo and who had a stable relationship with a female sexual partner were included. Patients older than 70 yr with penile anatomic abnormalities, cirrhosis, diabetes, angina, severe anemia, and those who were on nitrate treatment or with a recent history of stroke or myocardial infarction were not included. The International Index of Erectile Dysfunction (IIEF) was employed to evaluate ED and treatment response. Forty-one patients were evaluated (21 received placebo, and 20 sildenafil). Baseline clinical and demographic parameters were similar in both groups. Sildenafil was associated with improvement in the score of all questions and domains of the IIEF, except those related to sexual desire. Using the erectile function domain to evaluate primary efficacy, improvement was observed in 85% of the sildenafil patients compared with 9.5% of placebo patients. Sildenafil use resulted in normal EF scores in 35% of sildenafil patients. Sildenafil was well tolerated. Headaches and flushing occurred in both groups. Dyspepsia was reported by two patients in the sildenafil group. In conclusion, oral sildenafil seems to be an effective and safe treatment for ED in selected patients with chronic renal failure on hemodialysis.
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PMID:Efficacy of oral sildenafil in hemodialysis patients with erectile dysfunction. 1239 48

Case-control study comparing 81 patients with chronic renal failure (CRF) with 58 patients without renal disease who were evaluated by endoscopy of upper and/or lower gastrointestinal tract (GIT) for gastrointestinal bleeding or dyspepsia. The success of endoscopic examinations was the same in both groups. Patients with CRF more often underwent endoscopic examination because of gastrointestinal bleeding and they presented more often by hematochezia. Patients with CRF were more often found to have hemorrhagic gastropathy or duodenopathy and angiodysplasia of upper and lower GIT. However, duodenal ulcer was significantly more common in the control group without renal disease. Incidence of Helicobacter Pylori infection was low in both groups.
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PMID:[Gastrointestinal hemorrhage and endoscopic findings in patients with chronic kidney failure]. 1257 51


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